Endo Tracheal Endo Tracheal SuctioningSuctioning

Presented by-Presented by-

Jasleen Kaur Jasleen Kaur BrarBrar

Introduction.....Introduction.....

The patient with an The patient with an artificial airway is not capable artificial airway is not capable of effectively coughing, the of effectively coughing, the mobilization of secretions mobilization of secretions from the trachea must be from the trachea must be facilitated by aspiration. This facilitated by aspiration. This is called suctioning.is called suctioning.

WHAT IS SUCTIONING?WHAT IS SUCTIONING?

Endotracheal Endotracheal suctioning is the suctioning is the removal of secretions removal of secretions from tracheobroncheal from tracheobroncheal tree through an tree through an endotracheal tube with endotracheal tube with the help of mechanical the help of mechanical suction device.suction device.  

PURPOSESPURPOSES

          To maintain a patent airway by To maintain a patent airway by removing retained tracheobroncheal removing retained tracheobroncheal secretions.secretions.

          To prevent lower respiratory tract To prevent lower respiratory tract infection from retained secretions.infection from retained secretions.

          To provide effective ventilation.To provide effective ventilation.

          To stimulate coughing.To stimulate coughing.

INDICATIONINDICATION

Therapeutic Diagnostic

TherapeutTherapeutic:ic:

Noisy breathingNoisy breathing Visible secretions in the airwayVisible secretions in the airway Decreased SpODecreased SpO22 in the pulse oximeter in the pulse oximeter

& Deterioration of arterial blood gas & Deterioration of arterial blood gas valuesvalues

Patient’s inability to generate an Patient’s inability to generate an effective spontaneous cougheffective spontaneous cough

Presence of pulmonary atelectasis or Presence of pulmonary atelectasis or consolidation, presumed to be consolidation, presumed to be associated with secretion retentionassociated with secretion retention

During special procedures like During special procedures like Bronchoscopy & EndoscopyBronchoscopy & Endoscopy

DiagnostiDiagnostic:c:

The need to obtain a sputum The need to obtain a sputum specimen / ETA (Endo Tracheal specimen / ETA (Endo Tracheal Aspiration) for investigations.Aspiration) for investigations.

COMPLICATIONS COMPLICATIONS Hypoxia Hypoxia Tracheal or bronchial mucosal Tracheal or bronchial mucosal

traumatraumaCardiac or respiratory arrestCardiac or respiratory arrestPulmonary hemorrhage / bleedingPulmonary hemorrhage / bleedingCardiac dysrhythmiasCardiac dysrhythmiasPulmonary atelectasisPulmonary atelectasisBronchospasmBronchospasmHypotension / hypertensionHypotension / hypertensionElevated ICPElevated ICP

TYPES OF ET TYPES OF ET SUCTIONINGSUCTIONING

OPEN SUCTION CLOSED SUCTION

ASSESSMENTASSESSMENTPREPARATION OF PATIENT & PREPARATION OF PATIENT & ARTICLESARTICLESIMPLEMENTATIONIMPLEMENTATIONEVALUATIONEVALUATION

ASSESSMENTASSESSMENTPatient should be monitored prior to, Patient should be monitored prior to,

during & after the procedure for during & after the procedure for following :following :

Breath soundsBreath sounds Oxygen saturationOxygen saturation Respiratory Rate & patternRespiratory Rate & pattern Hemodynamic parameters (pulse rate, Blood Hemodynamic parameters (pulse rate, Blood

pressure)pressure) Cough effortCough effort ICP (If indicated and available)ICP (If indicated and available) Sputum characteristics (color, volume, Sputum characteristics (color, volume,

consistency & odor)consistency & odor) Ventilator parameters (PIP, Vt & FiOVentilator parameters (PIP, Vt & FiO22))

ASSESSMENT….ASSESSMENT….

Assess the Assess the depth and depth and rate of respiration, rate of respiration, auscultate breath auscultate breath sounds.sounds.

Assess for wheeze or Assess for wheeze or rattling sound in rattling sound in chest: chest: a harsh sound a harsh sound caused by partial caused by partial obstruction of the obstruction of the airwaysairways

Patient PreparationPatient Preparation

Explain the procedure to the Explain the procedure to the patient if conscious.patient if conscious.

The patient should receive The patient should receive hyper oxygenation by the hyper oxygenation by the delivery of 100% oxygen for delivery of 100% oxygen for >30 seconds prior to the >30 seconds prior to the suctioningsuctioning

Position the patient in supine Position the patient in supine position.position.

Auscultate the breath sounds. Auscultate the breath sounds.

COMMUNICATE……COMMUNICATE……

Explain the Explain the procedure to procedure to the patient the patient and and importance of importance of coughing if coughing if conscious.conscious.

EQUIPMENT EQUIPMENT ASSEMBLYINGASSEMBLYING

StethoscopeStethoscopeVacuum source with Vacuum source with

adjustable regulator adjustable regulator suction jarsuction jar

Sterile glovesSterile glovesSterile suction catheterSterile suction catheterProtective goggles, apron Protective goggles, apron

& mask& maskSterile normal salineSterile normal salineAMBU bag for pre & post AMBU bag for pre & post

oxygenationoxygenation

SUCTION CATHETERSUCTION CATHETER

   

Catheter can be selected according to the ET tube size. Sterile suction catheter of 12-14 Fr is used for adults and for children 8-10 Fr is used.

SUCTION PRESSURESUCTION PRESSURE

   

Turn on suction apparatus to appropriate negative pressure for:

adults-100-120 mmHgchildren-50-100 mmHginfants-40-60 mmHg.

IMPLEMENTATIOIMPLEMENTATIONN

HAND WASHHAND WASH Perform hand Perform hand

hygiene, wash hygiene, wash hands. It hands. It reduces reduces transmission of transmission of microorganismmicroorganisms.s.

Goggles, mask & apron should Goggles, mask & apron should be worn to prevent splash be worn to prevent splash from secretionsfrom secretions

Open the end of the suction Open the end of the suction catheter package & connect it catheter package & connect it to suction tubing (If you are to suction tubing (If you are alone)alone)

Wear sterile gloves with Wear sterile gloves with sterile techniquesterile technique

With a help of an assistant With a help of an assistant open suction catheter open suction catheter package & connect it to package & connect it to suction tubingsuction tubing

Continue…..

Continue…..Continue…..With a help of an assistant With a help of an assistant

disconnect the ventilatordisconnect the ventilatorKink the suction tube & Kink the suction tube &

insert the catheter in to insert the catheter in to the ETtube until resistance the ETtube until resistance is feltis felt

Resistance is felt when the Resistance is felt when the catheter impacts the carina catheter impacts the carina or bronchial mucosa, the or bronchial mucosa, the suction catheter should be suction catheter should be withdrawn 2cm out before withdrawn 2cm out before applying suctionapplying suction

Continue.....Continue.....Apply continuous suction Apply continuous suction

while rotating the suction while rotating the suction catheter during removalcatheter during removal

The duration of each The duration of each suctioning should be 10-suctioning should be 10-15sec.15sec.

Instill 3 to 5ml of sterile Instill 3 to 5ml of sterile normal saline in to the normal saline in to the artificial airway, if artificial airway, if requiredrequired

Give four to five manual Give four to five manual breaths with bag or breaths with bag or ventilatorventilator

Continue…..Continue…..Return patient to Return patient to

ventilatorventilatorFlush the catheter with Flush the catheter with

NS in the suction trayNS in the suction traySuction nares & Suction nares &

oropharynx above the oropharynx above the artificial airwayartificial airway

Discard used Discard used equipmentsequipments

Flush the suction tube Flush the suction tube with hot waterwith hot water

Wash handsWash hands

POST PROCEDURE POST PROCEDURE CARE…CARE…

    

When the procedure When the procedure is complete is complete hyperventilate the hyperventilate the patient again.patient again.

When the airway When the airway becomes clear, becomes clear, return the patient return the patient to ventilator or to ventilator or oxygen source.oxygen source.

DOCUMENTATION…DOCUMENTATION…

Record the time of Record the time of suctioning, nature & suctioning, nature & amount of secretions.amount of secretions.

Document indications Document indications for suctioning & any for suctioning & any changes in vitals & changes in vitals & patient’s tolerance.patient’s tolerance.

CAUTION..CAUTION..Suctioning is potentially Suctioning is potentially

an harmful procedure if an harmful procedure if carried out improperly.carried out improperly.

Suctioning should be Suctioning should be done when clinically done when clinically necessary (not routinely).necessary (not routinely).

The need for suctioning The need for suctioning should be assessed at should be assessed at least every 2hrs or more least every 2hrs or more frequently as need arises.frequently as need arises.

Thank youThank you